Because we have good health insurance, my son sees his endocrinologist twice a year, his diabetes health educator twice a year, and his nutritionist once a year. Meanwhile, he sees his school nurse one to three times a day. As you know, this relationship can make a difference for the rest of a child’s life.
This is how I begin my talks when I am speaking to school nursing groups.
Then I ask, “How many children with diabetes do you have in your care?” and I start counting, “One? Two? Three? Four?” When I first did this several years ago, nurses stopped raising their hands at around four. At my last diabetes conference for the Massachusetts School Nurse Organization, several hands were still up when I reached seven.
Not only are school nurses regularly interacting with our children, they are increasingly in charge of many children; some have pumps, some have continuous glucose monitors, some have oral medications, some have very involved parents who want a phone call every day, some have parents who don’t answer the phone.
At the same time, school districts are cutting costs by reducing school nursing hours. In California, some nurses are responsible for as many as 5000 students, so if your child has a full-time school nurse, you are lucky.
This nurse-student relationship can be a profound support for your child. Over the years, Danny has had three school nurses, and in each case, he had a strong ally. His school nurses reviewed his blood sugar numbers with him every day. They reminded him to test when he forgot. They checked with him before gym and sports, and they helped his teachers understand his disease.
I benefited as well. When Danny had a night of high blood sugars, I could call his school nurse and know she’d keep an extra eye on him. If she was worried about his numbers or needed more supplies, she knew she could reach me and that she had my support. Our school nurse became a central part of Danny’s medical team.
Over the years, I have spoken to school nurses who have trouble with their parents. “His mother calls many times a day and always thinks I’m doing something wrong.” “I ask him for more supplies, but he won’t bring them in.” “They send her in with cookies and a Snickers bar.” or “Their child comes in every day with sky-high blood sugars and they won’t do anything about it.”
When parents are unhappy, their complaints are different. “My son’s school nurse doesn’t know a thing about diabetes.” “Our school nurse hovers over my daughter. She doesn’t let her do anything herself.” “I never know which nurse will be in charge or if anyone will be there, so I have to do most everything myself.”
It helps to speak to nurses about the parenting experience. I remind them that approximately 20% of parents have full-blown Post Traumatic Stress Disorder during the first year after diagnosis. Many are anxious or depressed; others are financially stressed or exhausted from broken sleep. Some parents cope by worrying and trying to control things, others end up checking out. Mostly, I talk about the need for communication, for compassion, and for building trust. I recommend medical one-page handouts, face-to-face meetings, and a sense of humor.
With parents, I flip the coin. Many school nurses are spending their own money to buy Band-Aids and Kleenex. They eat lunch at their desks with children coughing on them. For a very low salary, they drive madly from one school to the next and stay late to do paperwork. There is very little time to read up on the latest diabetes technology or decide how much responsibility a child should take for his or her care. Still, I recommend the same things: communication, compassion, building trust, informational one-page handouts, face-to-face meetings and a sense of humor.
The benefits are worth it. For parents, a strong, supportive relationship with your school nurse can greatly relieve your anxiety, help to improve your child’s A1c, and be your liaison at school. Like a garden, this is a relationship well worth tending.
Tips for Working with Your School Nurse
- Prepare an emergency sheet with your child’s photo, your phone numbers, and your doctor’s protocol for treatment of low blood sugars.
- Develop “school orders” and plans for after school activities with your child’s physician and have them faxed to the school nurse in advance.
- Arrange a meeting with your child’s nurse before school starts to review the emergency sheet, the school orders and the Section 504 plan.
- Leave time for the nurse to meet with your child as well, so they can decide upon a daily routine that works for both of them.
- Ask your school nurse to facilitate a meeting with your child’s teachers and athletic coaches each year. Give them the emergency contact sheet and an introduction to your child’s diabetes routine.
- Keep in mind that school nurses are mandated to have physician’s orders to adjust insulin doses and carb ratios. Be prepared to coordinate communication between them should your child require changes in treatment.
- Calculate snack and lunch carbohydrates ahead of time when possible. This makes insulin calculations and nurse visits quicker.
- Check to see whether your school nurse has “diabetes lunch bunch” opportunities. These gatherings give students time to share school experiences and learn from one another.
- Meet with your school nurse at year-end to review the year and plan for any upcoming school transitions.